Global AIDS Conference Comes to U.S.

As 25,000 global experts descend on Washington, D.C., this week for the first International AIDS Conference in the United States in 22 years, they face some sobering statistics: 3 percent of all residents in the nation's capital are infected with the HIV virus.

And with 7 percent of all black males HIV-positive, the city has a higher infection rate than African countries like Ethiopia, Nigeria and Rwanda.

The world might be winning the war on AIDS -- 2.7 million had HIV in 2010, down from 3.2 million a decade earlier -- according to UNAIDS, but the United States, alongside Eastern Europe, still sees new infections.

Even with last week's FDA approval of the preventive drug Truvada and antiretrovirus therapies that have virtually eliminated the transmission rate from mother-to-child, a large U.S. population has not reaped the good news.

African-Americans, who represent 14 percent of the U.S. population, account for the largest group, or 44 percent of all new HIV infections and deaths in 2009, according to the Foundation for AIDS Research.

"There is still no cure for AIDS and the fact that we have reduced transmission rates has generated a lot of excitement," said Gail Wyatt, associate director of the UCLA AIDS Institute.

"Our challenges have to do with disparities we have always seen between those who can afford health care and those who are not in the health care system," she said. "We are talking about affordable care and who gets treatment and which populations are disenfranchised and have not gotten care and have no insurance. The same issue has not gone away with the availability of new treatments."

Overall, African-American men represent 70 percent of all new infections in that group, a rate six and a half times that of Latino men or black women, according to the Foundation for AIDS Research.

The rate for heterosexual black women was 15 times the rate of white women and more than three times that of Latinas.

Some say America has a lot to learn from Africa in the fight against HIV/AIDS. But Wyatt argues that little attention has been paid to the U.S. crisis.

"An important point is that we are outsourcing our funds to Africa to stem the tide thousands of miles away, while we ought to provide the same concentrated efforts in America," Wyatt said. "Our policies need to take care of those at home and not be siphoned off."

The biggest obstacle has been getting those who are most at risk tested. African-American communities are plagued with the highest unemployment and crime rates and the fewest number of health resources.

"You need to create a different system to testing people, to make them feel comfortable being tested," Wyatt said. "When the [AIDS epidemic] first started, there was no need to get tested because there was no treatment. There were no clinics available or doctors they know or are comfortable with. These are barriers to care in a vulnerable community."

The highest infection rate is among men 13 to 29 who have sex with males, according to the CDC.

"It's an extreme concern and it's been overlooked for a long time," said Wyatt's colleague, Dr. John Williams, a professor of psychiatry at UCLA's AIDS Institute.

Some blame homophobia in the African-American community for preventing males from coming out about their sexuality and infecting female partners.

But, Williams said, the reasons are "more complex."

"There is a subset of men who are bisexual and not disclosing and also a group of men who fluidity across sexuality at different times in their lives," he said. "Incarceration is also a huge problem for black men."

He and Wyatt point to the gay white community that convinced the federal government to raise money in the fight against AIDS when the epidemic came to the national forefront in the mid-1980s. They have "served as a model for the rest of the world," they said.

Such efforts have not been replicated in the African-American community, which needs its own leaders and to be able to "heal themselves," Williams said.

Cornelius Baker, senior adviser for the National Black Gay Men's Advocacy Coalition, said poverty, culture and behavior contribute to new infections.

"For men in the African-American community, broadly, a high level of unemployment persists ... 15 to 30 percent, double or three times the national average. When you have an environment of that kind of endemic poverty, it certainly facilitates more drug use and sex work and almost a futility of life," he said.

"Prevention is an act of protecting your future. If you are in a culture that doesn't believe it has a future, than what becomes important is that moment and the decision to have unprotected sex."

In impoverished communities such as Washington, D.C., there might be access to health care but a lack of "health literacy," Baker said.

People don't get regular check-ups.

As for younger men, "they don't think anything is going to happen," he said.

And in a compact city like Washington, where there is little economic mobility, the virus circulates more virulently.

"These men don't have more sex or more drug use than their white, gay, counterparts, but they are in an environment that has more disease, more poverty and more HIV present in the community," Baker said. "They may have only one partner, but there is a greater likelihood, he has HIV."

Washington is a city where most have access to health coverage, but there are no hospitals in the African-American neighborhoods.
"Few doctors are based past 16th Street in Northwest [D.C.]," Baker said. "People have to travel all the way across city to go to doctor."

He argues that the African-American community is no more religious and socially conservative and than U.S. Catholics.

"The difference is that the Catholic Church may condemn using birth control, but women have enough economic opportunities to ignore it," Baker said. "The challenge for young, black, gay men is not that there is a greater level of homophobia, but they are dependent on their families and communities for their survival."

Numerous African-Americans have helped lead the way, Baker said. The first significant bill was enacted by Gov. Willie Brown of California in 1972, followed by other black leaders in Washington, D.C., Chicago and New York City.

President Obama lifted a ban on travel visas for those who are HIV positive, making this week's U.S. conference possble.

"This concept that black people haven't been major partners or homophobia paralyzes us is false," Baker said.

Still, the statistics speak volumes and AIDS experts say more strategies need to address the rising number of HIV infections in these communities.

"Getting more and more people aware of their status is critical," Baker said. "Getting people to the treatment they deserve is not only a fundamental public health, but a fundamental human rights goal."

As for young African-American men, he added, "we have to prove to them that their lives matter."